The Skype Appointment: Careless Technology?

Niqui Stubbs is a 4th year medical student at the University at Leeds who has a particular interests in medical technology and medical negligence. She also has a passion for writing and currently works on behalf of medical negligence firm Pannone, for whom she writes articles for.

With around 835,000 people making an appointment to see their GP every day, there is bound to be a large number of those to fail to turn up without phoning to cancel their appointment. This is extremely selfish, as that appointment could have been given to someone who actually needed it but could not be fitted in because the surgery was too busy. One in 10 people fail to turn up to their appointment, and whilst some may have a valid reason for not cancelling it, there are others who are happy to waste a doctor’s very valuable time.

As I have just said, some people may not be able to attend their appointment for valid reasons such as being too ill to leave the house, being old and frightened of leaving the house, or they may live in a very rural area and have no way of getting to a surgery. It is because of these reasons that Jeremy Hunt, the health secretary, is supporting a new era of Skype consultations.

A pilot Skype scheme has been running in a hospital in Newham and has shown some very favourable results; namely a decrease in missed appointments by 11%. Patients involved in the scheme say that the level of care they receive through the video consultation is not different from that of a face-to-face appointment, and they preferred this kind of communication to the standard telephone call. But could this idea of virtual consultations bring about more harm than good?

In medical school you are taught that 80% of a diagnosis comes from a thorough history from the patient, but there is still that crucial 20% which is made up of the physical examination; something that is not possible over a video chat. A doctor needs to be able to examine a rash to make sure it is not something sinister such as meningitis, otherwise it could be confused with a simple virus or dermatitis; the Skype consultation may well bring about an increase in medical malpractice claims because of mistakes just like these. The physical examination is key, because not only does it allow the doctor to confirm a diagnosis they may suspect from the history, but it also gives them chance to pick up on signs that the patient themselves may not have been aware of. The patient may as well just type their symptoms into Google and see what comes up, because without the examination it is essentially the same thing.

The doctor-patient-relationship is a sacred thing which stems from the trust and respect that a patient has for their doctor, which is a result of good rapport building during face-to-face encounters. A video consultation just cannot compare with this! The video consultation takes away that air of professionalism that is held by the doctor, which causes the patient to hold what they say with the utmost respect and faith; if this is lost the patient may lose faith in what their doctor says, as they are no more than a face on a screen.

Another issue that needs to be considered is that of patient confidentiality: can this ever be possible when a consultation is done online? You cannot rule out the possibility that the consultations will never be hacked because it is only a matter of time before someone creates a software that is built just for this purpose. A patient needs to be sure that everything they say to their doctor is strictly between the two of them, otherwise they will lose that trust and fail to tell the doctor everything they need to hear.

For the Skype consultation to be successful it needs to be used properly and not abused by patients who are too lazy to leave their house. The appointments need to be reserved for people who cannot physically get to the clinic because of either a physical ailment or of transport issues. If it is done correctly this system could save the GP a lot of time, as they will not have to attend as many house visits, and as a result they will be able to see more patients per day in the clinic.

How would you feel about Skyping your doctor? Would you feel as though your health requirements had been met?

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